The Science Journal of the American Association for Respiratory Care

2005 OPEN FORUM Abstracts

THE IMPACT OF CORE TEAMS ON RESPIRATORY CARE PRACTICE IN A TEACHING INSTITUTION - A Case Report

Jhaymie Cappiello RRT, Janice Thalman RRT, Duke University Medical Center, Durham, NC

Background: Current trends in health care have expanded the scope of practice for respiratory care practitioners (RCP's) to include some non-traditional therapies. Examples of this include nitrous oxide administration, nitric oxide administration, heliox administration, Non-Invasive Positive Pressure Ventilation (NPPV), arterial line insertion and bronchoscopy assistance. This professional growth could not have occurred had it not been for a history of clinical excellence, availability and professionalism of the respiratory staff. To further enhance the impact of the RCP, there has been notable advantage in assigning therapist teams to specialty groups beyond the customary adult and pediatric sub-groups. This " Core Team" approachment results in a therapist who is a team member that is specialized to a particular intensive care unit or area. This familiarity of staff and service enables the refinement of skills, increased confidence between all health care providers and open dialogue with the physician staff to assess and refine delivery of patient care. We report a case to illustrate the importance this concept.

Methods: Dexamethasone, the current steroid of choice for the treatment of croup, is experiencing a national supply shortage. The use of inhaled budesonide for the treatment of croup has been discussed in recent literature. The RCP assigned to the emergency department was asked to deliver budesonide as an alternative treatment in a mild to moderate croup case. The benefit would be rationing dexamethasone and the patient would not require a needle stick. The core team therapist performed a literature search on budesonide versus dexamethasone for croup, medication uptake in the pediatric patient via nebulizer and an in house cost analysis of the two therapies.

Results: A report was made to the Chief of the Pediatric Emergency Department with the following assessment:

a) There is no documented evidence to support that croup responds as good or better to budesonide (1,2),

b) Dose delivery to the patient is unreliable (3), and

c) The in house cost of therapy was 8 times greater with budesonide.

The physician was responsive to the therapist recommendation and this new nebulized agent for the treatment of croup was not initiated. Furthermore, the results were communicated to resident physicians so that more cost-effective care would continue for future like-cases.

Conclusion: Using the core team approach, therapist knowledge base and contribution to the clinical care "team" enhance and streamline patient care. This case demonstrates that core team concept. Intervention in the initiation of an unproved therapy prevented an increase in hospital expense, strengthened the therapist/ physician professional relationship and solidified the impact of the RCP at the bedside.

1) A comparison of nebulized budesonide, intramuscular dexamethasone and placebo for moderately severe croup. New England Journal of Medicine, 11198, Aug 20

2) Pseudocroup treated with inhaled steroids. Adouble blind controlled trial. Pediatric Pulmonology, Vol 20

3) Consensus Statement; Respiratory Care Journal, Aerosols and Delivery Devices

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